Group run by academics from University of Bristol Medical School with an interest in Medical Education Research. Opinions expressed are those of the authors and not of Bristol Medical School or the University.
The mission and aim of the ClinEdR Incubator is to support and promote careers in clinical education research through building a multi-professional community of practice. It extends across all health professions and aims to bring people together to develop their ideas, build collaborations and provide a network of developing experience in the field.
What is Clinical Education Research?
This is one of the most fundamental questions and tends to have a myriad of different definitions and terms including clinical, medical, and healthcare professionals education research to name just a few. Often the word ‘clinical’ can drive the idea that this sort of research must have a direct impact in clinical practice and thus can seem to exclude certain areas of research in education.
The team at the Incubator have tried to broaden this idea, embracing all sorts of different research that can and does have an impact on societal health needs by “enhancing the education, training and development of health and social care practitioners, and the organisations within which they work and learn“. They highlight a number of different areas in which individuals and teams may be undertaking clinical education research such as:
Pedagogical research
Planning and design of educational programmes
Regulation processes
Organisation context of learning, such as learning environments and workforce inclusivity
Learner experience and careers
They also consider that this whilst this type of research may have a direct clinical impact for patients it may achieve impact in other ways such as benefiting clinicians in their training, influencing health and education systems and through challenging and developing standards.
How can the Incubator help those who want to engage in Clinical Education Research?
The incubator is a fantastic place to start regardless of where you are in your ClinEdR journey. It offers a variety of resource and links via it’s website such as:
This week’s blog is from Dr David Hettle, hot off the recent announcement of winning the ASME/GMC Excellent Medical Education Award (postgraduate category). David tells us a bit more about the planned research project with colleagues across the country, exploring the experiences of doctors undertaking an entry-level medical education roles (ELMERs).
Image from ASME Awards page
Lisa-Jayne Edwards (University of Warwick), Claire Stocker (Aston University), Julie Browne (Cardiff University), Cara Bezzina (University of Glasgow), David Hettle (University of Bristol)
Introduction
More and more doctors take time out of clinical training, with many choosing to undertake teaching posts during years out, especially ‘F3 years’: time out of training after your initial standardised two years post-graduation1, the ‘Foundation Programme’. These teaching posts have a variety of names including Clinical Teaching Fellows (as they are locally in Bristol), Teaching Fellows, and Education Fellows.
With the increasing need for educators, these posts host a crucial place for doctors developing interest, skills and expertise in medical education as they progress in clinical and educational training. Therefore, there is need to understand the landscape of educational practice which these positions deliver and support the development of these current educators and future educational leaders.
Previous work reviewed the current landscape of entry-level education posts across the UK, finding over 400 positions per year in the UK in 20232, up from 77 in 20083. Though the numbers of these posts have increased, due to the variety of different titles used and the often transience of the doctors in these positions, research into posts is challenging. Importantly this means research into the quality of these posts remains under-studied.
Why does this matter?
This research holds great opportunity to really find out how early-career educators can be supported. Currently, there seems to be wide variation in the quality of posts, with some offering financial support for educational accreditation, others designated time to teach and develop skills in specific aspects of education.
On the flip side, they are others without any additional time, support or links to educational teams offered, yet still carrying responsibility for others’ learning. This work hopes to facilitate more information and some degree of quality control for early-career educational roles as occurs with other medical specialties, for example through their colleges and specialty societies.
The ELMER study
Building on our work undertaken alongside the Academy of Medical Educators (AoME), this new project through the Association for the Study of Medical Education (ASME) seeks to explore the perspectives of current early-career education post-holders. We will investigate how different role qualities and opportunities impact their experience within medical education and, as a result, doctors’ inclination to pursue future teaching and training responsibilities once they move on from these posts (often back into clinical training).
To encompass all similar roles, our research team has chosen to use the term ‘Entry-Level Medical Education Role’ or ELMER as an individual’s first formal role in medical education.
We will use these doctors’ experience in their ELMERs to identify factors which promote formal teaching and increased educational activity and development. We have positioned the study in a pragmatic paradigm, focusing on the interaction between individuals (i.e. ELMER post-holders) and their environment, emphasising experiential research, and actionable knowledge. The study will use a mixed methods approach using a survey, followed by interviews, inviting any current ELMER post-holders to take part. Qualitative data will be analysed using reflexive thematic analysis, developing and telling the story of current ELMER post-holders.
Alongside the prior review of ELMER posts across the UK, the primary objective of this integral work is to offer insights that can inform policy decisions on how ELMER roles can support doctors in training to become future trainers, assessors, and leaders in medical education.
Why is this work so important to me?
As someone who has been a CTF in the past, but having finished that formal role wondered ‘where next?’, this work adds to the evidence for the development of a more formalised medical education career pathway, supporting educators of the future, alongside their clinical training. The current lack of such a pathway risks losing excellent educators after their ELMER posts, a risk which the field of medical education should not leave to chance.
Watch out for details of how to be involved soon if you are an early-career educator, ‘ELMER’ – we’d love to hear your experience! Drop me an email at david.hettle@bristol.ac.uk if you want to hear any more before then.
References
Church HR, Agius SJ. ‘The F3 phenomenon: Early-career training breaks in medical training. A scoping review’, Med Educ 2021; 55(9): 1033-46.
Hettle D, Edwards LJ, McCormack R, et al. (2023, Dec 4-5). A UK-wide review of Entry-Level Medical Education Roles (ELMERs) [Poster presentation]. Developing Excellence in Medical Education, Manchester, UK. https://www.demec.org.uk/category/demec-2023/
Wilson S, Denison AR, McKenzie H. A survey of clinical teaching fellowships in UK medical schools. Med Educ 2008; 42(2): 170-5.
We are thrilled to share that one of our BMERG Medical Educators, Dr David Hettle has been recently awarded one of the ASME/GMC Excellent Medical Education Award 2023!
Photo credit: Brett Garwood on Unsplash
The “Excellent Medical Education” Programme was established by ASME to supporting capacity building of high-quality medical education research. David is part of the team that has won this award in the postgraduate category for their submission: Exploring the experiences and perspectives of junior doctors in Entry-Level Medical Education Roles (ELMERs) that promote pursuit of a medical education career in the United Kingdom.
WINNER OF THE POSTGRADUATE CATEGORY
L-R: Lisa-Jayne Edwards (University of Warwick), Claire Stocker (Aston University), Julie Browne (Cardiff University), Cara Bezzina (University of Glasgow), David Hettle (University of Bristol)
We look forward to hearing more about this work from David and his colleagues in the future.
This week’s blog is a reminder to check out the BMERG profiles pages. This is where we highlight some of our University of Bristol Medical Educators. They share their projects and their journeys to inspire others considering a career in Medical Education.
Our latest profile is Dr David Hettle, a passionate educator working as an Honorary Senior Clinical Teaching Fellow, alongside clinical training in Infectious Diseases and Microbiology. They are involved in work supporting and promoting educator development both locally and nationally through work with the Developing Medical Educators group (DMEG) of the Academy of Medical Educators.
Adding to our BMERG Journal Club series, this month Dr Claire Hudson reflects on the discussion from our January journal club focussing on Cultural Competency.
This paper was chosen by my colleague, Assoc. Prof Liang-Fong Wong, who has a combined interest in cultural competency and medical education, being Year 4 co-lead for our undergraduate MBChB programme and Associate Pro Vice-Chancellor for Internationalisation. Both Liang and I are keen to develop our qualitative research skills, and at first glance, this paper seemed like an excellent example of a qualitative study.
What is ‘Cultural Competency’?
Liu et al suggest culturally competent healthcare professionals should “communicate effectively and care for patients from diverse social and cultural backgrounds, and to recognize and appropriately address racial, cultural, gender and other sociocultural relevant biases in healthcare delivery”; others have defined attributes of culture competency including “cultural awareness, cultural knowledge, cultural skill, cultural sensitivity, cultural interaction, and cultural understanding”. These concepts were explained effectively at the start of the paper; I felt the authors provided me with context for my subsequent reading.
What was the research?
The authors perceived that teaching of cultural competency is inconsistent across medical schools, and there is a paucity of evidence for how effective the teaching is, and how students actually develop their cultural competency throughout their training. They aimed to describe students’ experiences of learning and developing cultural competency, using an ethnographic approach. They carried out student observations, interviews and focus groups; recruiting participants from a central London medical school.
What were the findings?
There is a wealth of qualitative data and discussion presented in the paper, so perhaps the authors could summarise their overall findings in a clearer way. They suggest that students develop cultural competency in stages; in the pre-clinical years they have formal teaching opportunities, and as their clinical exposure increases, the culture content becomes embedded and derived from other learning experiences, including intercalation and placements. They highlight the importance of learning from patients’ lived experiences, from peers and from other (non-medical) student communities.
What did we think?
Clear descriptions: I come from a quantitative, scientific background, therefore I find reading qualitative papers quite challenging; the terminology used is noticeably different and somewhat out of my ‘comfort zone’! Having said that, the authors very clearly explained the basis of ethnography and reflexivity, which really helped us understand the rationale for them adopting these approaches. Data collection and analysis were explained in detail which reassured us that these were robust and valid. However, thorough descriptions mean a long paper; and it could be more concise in places.
Awareness of limitations: A strength of this research was the authors’ transparency about some of its limitations. For example, they acknowledged a potential bias in participant recruitment due to the main author’s own cultural background, but described ways to mitigate this. We found it really interesting that the authors observed different dynamics in the interviews and focus groups depending on the facilitator. In those conducted by a PhD student, a rapport was built such that the students were relaxed and open with their communication, allowing them to be critical about the cultural competency teaching they had received. Conversely, in those conducted by a medical school academic, students were more reserved and tended to be positive about the teaching, highlighting an obvious teacher-student power dynamic. Importantly, this was acknowledged, and adjustments were made. Our biggest take-home message: Carefully consider who facilitates interviews and focus groups so there are no conflicts of interest, and trust is fostered between participants and researchers. Otherwise, students may just tell you what you want to hear!
Evaluation to recommendations: We also remarked that the authors have been clever in the way they present this study for publication. Essentially, they have carried out an internal evaluation of cultural competency teaching in their own medical school, but they have externalised this by making a series of recommendations. They benefit from a very diverse student population, and showcase some really good practice in cultural competency teaching which could be adopted by medical schools.
Overall reflections
Reading this paper made us reflect on non-clinical teaching on other programmes; it is important to remember that diverse student populations increase cultural awareness in all settings. Widening participation schemes and overseas students are important for this. During group work, I try to make the groups as diverse as possible, and I believe this is a positive experience.
The study highlighted different levels of engagement from students with cultural competency teaching, some thought it was ‘pointless’ as they were already culturally competent, or they thought the skills were ‘soft’ and would rather be learning facts, other found it really valuable. This is familiar when teaching other skills in other disciplines; the constant battle getting ‘buy-in’ from students, highlighting the need to always explain ‘Why’ certain teaching is important.
This study is a good showcase for qualitative research, and I made a mental note to refer back to this paper when developing my own qualitative research in the future; which must be a good sign!
In this blog Dr Sam Chumbley and Dr Ed Luff invite you to The Inaugural CTF Conference: TICC GW4, hosted by the University of Bristol in collaboration with BMERG.
TICC GW4 provides an opportunity to see and present the valued work of Clinical Teaching Fellows (CTFs) from across the GW4 Alliance Medical Schools of Bristol, Cardiff, and Exeter. Building on the successes of last year’s Inaugural CTF Conference at the University of Bristol, which brought together CTFs from Bristol Medical School’s regional academies, we have expanded this year’s meeting, to invite presenters from the GW4 Alliance Medical Schools, Bristol, Cardiff, and Exeter.
One of the highlights of this year’s expanded interinstitutional conference will be a keynote from Dr Jo Hartland, Senior Lecturer and Deputy Education Director at Bristol Medical School. They will be presenting an account of their work in the field of Equality, Diversity and Inclusion.
There will also be presentation options for CTFs from the GW4 Alliance, in a variety of formats, including Research, Innovation and Opinion Pieces. Authors can choose to submit abstracts for consideration as a Showcase presentation (20 minutes), Oral presentation (10 minutes), Poster presentation (3 minutes) or for display as an e-Poster, which requires no presentation on the day. Opinion Pieces can also be considered for an Open Forum (30-minute) platform of discussion. There will also be a variety of workshops run on the day, to help develop delegates’ research and clinical academic skills.
All those involved in the teaching or support of medical students, be that clinical, academic, or administrative, are welcome to attend the conference. However, presentations will only be open to Clinical Teaching Fellows from the GW4 Alliance Medical Schools.
Registration is free and lunch will be provided. TICC GW4 will be held in Bristol on the 5th of April 2024. Further details will be sent following registration.
To register for the conference or to submit your abstract for consideration for presentation at the conference, please follow this link: TICC GW4 Registration
Registration will close nearer to the conference date.
The deadline for submission of abstracts is 12:00 on Friday 8th March 2024.
This latest blog in our publishing series is a must read for all researchers, not just those in medical education.
In this blog research support librarian Kate Holmes will introduce you to Open Access publishing, why it matters, a few handy tools, and how it might influence where you decide to place your article.
Open sign by Viktor Forgacs (Unsplash)
You’ve decided you want to write an article. You’ve thought about your structure, maybe using some of the support and advice from this blog. Maybe you’ve even begun to think about where you’d like to place it. So, how might publishing Open Access influence the process?
What is Open Access?
Open Access (OA) is free, unrestricted online access to research outputs.
This means that anyone with an internet connection can read your work because it is available without someone having to go through a paywall or log into a system.
There are two common routes to Open Access:
Gold: where the library pays the publisher to make the article available on the publisher’s website free of charge to readers, with their formatting and copyediting.
Green: where you upload the Author Accepted Manuscript to an online data repository such as Pure for anyone to read. (This is the last word document you sent the publisher prior to copyediting and typesetting.)
The UK Reproducibility Network have a great introducing the open research practice of open access and why it is important:
Why do it?
Research Culture
Paywalls prevent people from reading your research because not every institution can afford to pay for subscriptions to every journal. This means that much of the research conducted is inaccessible to researchers who don’t have access to libraries with large budgets, such as those in the global south, or to patients who want to learn more about their own conditions.
Unsurprisingly, Open Access articles are read and cited more, allowing them to make more impact in the academic community and to interested parties, such as patients.
Choosing to publish Open Access means that you are participating in open research practices and a movement that aims to improve research culture. These practices improve research rigour by being as transparent as possible about how research is done.
Publishing Open Access is one element of open research; you can see it as the front door to wider open research practices.
Funder requirements
Publishing Open Access is required by some funders like the UKRI’s Medical Research Council, British Heart Foundation, Wellcome Trust and Cancer Research UK. These organisations provide funds to cover Gold Open Access costs for the research they have funded. You can find out if you can request these funds by contacting your institutions library and filling out an open access form (see also University of Bristol Article processing charge guidance).
If this is the case, your funder will commonly ask you to:
It is important that you include this information and that you publish your article Gold Open Access because this is a condition of their funding your work. Seek advice from your institutional OA team for the specific details of funder requirements so that they can help you understand them more (see also University of Bristol Open Access Policies). Note, not complying may lead to a funder blacklisting an institution or imposing financial penalties.
Research Excellence Framework (REF) 2029
The Research Excellence Framework (REF) is the UKs system for assessing the quality and impact of UK research. We’re still waiting to hear exactly what the Open Access requirements are going to be for REF 2029. However, we currently need to ensure that we upload the Author Accepted Manuscript to Pure within 3 months of its acceptance for the article to be eligible to be submitted as part of REF.
Many institutions, including Bristol, have developed policies to support researchers to make their work more accessible. At Bristol this is the University’s Scholarly Works Policy, which supports researchers to post the accepted version of articles to the online repository (Pure) in a way that meets REF and funder requirements. If you do not manage to upload your article in time, then there are sometimes ‘exceptions’ that can be applied, and your library team can help you with this.
What might this mean for choosing where you place your work?
Publishing Open Access benefits society and is part of your duty as a good researcher. The good news is that you can choose how your work appears by making choices about where you publish.
Although Green Open Access publication is great and can be cited in the same way as a journal’s formatted article, most people prefer to have a free version of their article available on the publisher’s website.
If you want this to happen, there are a couple of different routes you can take:
Diamond Open Access: no fees to authors or to readers, making all research free to read and free to publish. These journals are typically funded by libraries and scholarly organisations.
Gold Open Access: final published version of the research is made open access on the publisher’s webpage in exchange for a fee. If you don’t have funding, you can often still publish Gold Open Access (where the library pays a fee). As part of the journal packages your library buys for you to read, OA teams can make articles in certain journals Gold Open Access. These are known as ‘Read and Publish’ agreements. Your library will often have a directory where you can check whether the journal you are interested in is covered, e.g. UoB Read and Publish deal finder tool.
If you want to make the most of your research, then incorporate choices about Open Access into your journal selection process. That way, it can support you to communicate your research as widely as possible!
More author the blog author:
Dr Kate Holmes advocates for Open Access as a Research Support Librarian. She uses her experience in research to help academics understand more about the benefits of Open Access and the requirements they need to fulfil.
Have you seen our educator and researcher profile page? As part of our objective to ‘Innovate and Inspire’, this page is dedicated to showcasing not only the work of individuals working as educators and researchers in medical education at Bristol, but also a bit about their journey and their top tips for working in the discipline.
This month our featured educator is Dr Grace Pearson, a clinical lecturer and specialty doctor in Severn deanery.
Following her recent completion of a Ph.D. Fellowship in undergraduate education in geriatric medicine, Grace is actively innovating and evaluating geriatrics curricula on both local and national scales. This strategic approach ensures the continual enhancement of medical education in geriatric medicine.
To learn more about Grace’ Pearson’s work and that of other educators at Bristol Medical School, we invite you to explore their profiles on our BRMS Educator Profiles page.
In the second hot topics blog of 2024, Fiona Holmes considers the benefits and challenges of interdisciplinary learning. The inspiration for this came from teaching Clinical Perfusion Science students (clinical scientists who operate the heart-lung bypass during cardiac surgery) who come from different disciplinary backgrounds (bioscience/bioengineering and nursing/ODP), and who learn together and from each other and work as part of a complex multidisciplinary team.
The World Health Organisation defines interdisciplinary learning (IDL) as ‘students from two or more professions learning about, from and with each other to enable effective collaboration and improve health outcomes’ and has stated that ‘interprofessional education and collaborative practice can play a significant role in mitigating many of the challenges faced by health systems around the world’.
What are the benefits of IDL?
Shared knowledge. Healthcare students face careers in increasingly complex healthcare systems where mutual understanding and integration of complementary expertise, communication, collaboration and decision making is key to comprehensive patient care and best outcomes. Medical issues and clinical situations often require a holistic understanding that goes beyond a single discipline; generalists and specialists need to work together. Practioners can’t know everything about everything!
Widened horizons. IDL can help students appreciate the interconnectedness of various factors important for patient care such as physiological, psychological, and social. IDL can expose students to different knowledge and perspectives such that they can analyse complex cases from different angles and integrate knowledge leading to more effective problem-solving in clinical settings. It can increase the ability to recognise bias, think critically and tolerate ambiguity.
Effective teamwork. IDL develops effective communication, collaboration and teamwork among healthcare professionals, important for delivering comprehensive and coordinated patient care. This can better prepare students for work in diverse healthcare settings and equip them with broader skills, enabling them to be more versatile and adaptable in their careers and enhancing their professional development.
Improved student experience. IDL can improve the student experience; by and large studies have shown that students express higher levels of engagement and satisfaction when exposed to IDL, which can contribute to improved learning outcomes.
How can IDL be implemented?
IDL can be incorporated into medical education in a number of ways, but to be effective it needs to be purposefully integrated into the curriculum and explicit in learning sessions (you can’t just throw students together and expect the learning to happen spontaneously). IDL lends itself to learning opportunities that can be designed to be authentic real-life situations such as:
Case-based learning (CBL) – students work together on case studies that require input from various professions to help them understand each other’s roles and contributions to patient care;
Simulated scenarios / role playing– students from different professions (or playing the role of different professions) collaborate to address the simulated patient’s needs, honing their teamwork and communication skills in a safe environment as well as understand the perspectives and responsibilities of each profession;
Interprofessional clinical experiences – students from various professions complete clinical placements together to expose them to the interprofessional dynamics of healthcare delivery in reality;
Team-based learning (e.g. clinical rounds)– students discuss patient cases and treatment plans collaboratively (builds upon CBL);
Interprofessional workshops/projects – bring students from various disciplines together to collaborate and develop solutions for healthcare challenges;
Reflective practices – such as team debriefing sessions and individual reflective journals to contemplate experiences, challenges, insights and opportunities for improvement, with a focus on the IDL.
What are the challenges of IDL?
Resource implications. Implementing IDL can pose logistical and resourcing (appropriately skilled staff – ideally interprofessional team teaching, time, costs) challenges; it can be difficult to coordinate curricula and schedules to bring different healthcare students together at appropriate time in their educational journey.
Timing. The jury is out as to when is the best time to implement IDL and for how long (e.g., periodic exposure or continuous immersion). Ideally team dynamics need time to develop, so communication becomes more open and collaborative, with trust and appreciation of diversity of knowledge.
Experience levels. While the point of IDL is to bring together diverse students for learning, there may be issues associated with this such as: Learner-level matching (do they have sufficient background knowledge and experience to work together effectively?); differences in learning preferences may be more exaggerated due to prior teaching and learning experiences; epistemics (the disciplinary ideas about what knowledge is and how to use and produce knowledge) and specific manner of communication are part of the culture of particular disciplines that may hinder IDL.
Perceptions and Biases. Perceptual barriers in competence perceptions may lead to a lack of self-confidence or respect for co-learners and personal characteristics such as curiosity, respect, and openness, patience, diligence, and self-regulation have been suggested to be important characteristics for enabling cognitive advancement in IDL.
Measures of impact. Evaluating the effectiveness of IDL can be challenging. Traditional assessment methods may not adequately capture the depth and breadth of knowledge, behaviour and attitudes or ‘interdisciplinary thinking and doing’ – i.e., the capacity to integrate knowledge and ways of thinking and doing across areas of expertise to produce a better outcome than could be achieved otherwise.
Future Research
While the general consensus is that IDL should be an integral part of the curriculum for healthcare students, the importance of IDL is largely based on theory and there remains a lack of large, multi-centre long-term studies. Therefore, currently it is unclear what strategies are best for long-term behaviour change and positive patient outcomes.
In this blog, Dr Liang-Fong Wong shares some key insights into how we foster an inclusive environment for international students within our university academic systems and culture.
This is an area of work that is close to my heart – being an international student at Bristol myself many moons ago, my international roles, and serendipitously, it was being organised by my netball teammate Catriona Johnson, from the Centre for Academic Language and Development (CALD).
L-R: Assoc Prof Liang-Fong Wong, Dr Fiona Holmes, and Dr Claire Hudson at BILT International Student Experience workshop, 2023.
Catriona and I had previously shared many courtside and car conversations about her project work on academic language and literacy, but have never interacted within our work capacities. I was delighted to turn up on the day to find fellow BMERG members Fiona Holmes and Claire Hudson there as well!
International staff and students are an important community at our institution: they are invaluable to the diversity of our campuses, adding richness and vibrancy to our learning environments and making us all much better global citizens for now and the future. There is so much that we can learn from each other across different cultures.
During the session, we were given an overview of the numerous BILT-funded projects across the university that explore themes such as increasing inclusivity in the international classroom, decolonising curricula and developing sense and belonging.
Fiona Hartley (BILT/CALD) presented the ‘3 shocks’ that international students can experience:
Pedagogical (knowing what to expect academically)
Language (how to express oneself academically)
Cultural (feeling a sense of belonging and community in Bristol)
What was really interesting was the observation that some of these shocks may not be unique to international students, and indeed may be familiar to others in the wider student population, particularly first-year students.
We discussed in small groups how different schools use effective interventions and ways to enhance teaching and learning experience within and outside of the classroom. There were so many great examples, such as:
optional induction modules
allocating groups and facilitating group work sensitively
Through sharing experiences across the whole university and across disciplines, it gave us ideas on how we can implement some of these strategies in our own practices.
All in all, I really enjoyed the session; it was such an enriching discussion and I got to know many people outside of the medical school.
Dr Liang-Fong Wong is one of the University of Bristol’s Associate Pro-Vice Chancellors for Internationalisation as well as working as an Associate Professor in regenerative medicine. She also works with the undergraduate students as the Year 4 co-lead for the medical programme and is one of the inaugural members of the BMERG committee.
